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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880645
Report Date: 05/04/2026
Date Signed: 05/04/2026 12:02:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2021 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20210623121750
FACILITY NAME:BELLA VILLAGGIOFACILITY NUMBER:
331880645
ADMINISTRATOR:JIM GERMYNFACILITY TYPE:
740
ADDRESS:40235 PORTOLA AVETELEPHONE:
(760) 607-5200
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:170CENSUS: 142DATE:
05/04/2026
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Eloiza CastellanosTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not address a resident's toileting needs while in care.
Resident was left soiled while in care.
Resident sustained an injury from a fall while in care.
Resident was charged for services not received.
INVESTIGATION FINDINGS:
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On May 4, 2026, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced follow-up visit. This report is a corrected version of the LIC9099 and LIC9099C forms created on November 23, 2025, to incorporate additional information regarding the allegations investigated by Licensing Program Analyst (LPA) Michael Cava. During the visit, the LPA met with Administrator Eloiza Castellanos and explained the purpose of the follow-up visit.

On November 23, 2025, LPA conducted interviews with the Administrator (A1), Business Manager (BM), three staff members (S1-S3), and ten residents (R2-R11). A physical plant inspection and a record review were also conducted to ensure that residents' incontinence care and toileting needs are met and that the facility is properly maintained and odor-free. LPA was unable to interview R1 because R1 no longer resides at the facility and R1’s current location is unknown.

Reports Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 18-AS-20210623121750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLA VILLAGGIO
FACILITY NUMBER: 331880645
VISIT DATE: 05/04/2026
NARRATIVE
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Staff did not address a resident's toileting needs while in care/Resident was left soiled while in care.

Regarding the allegation, it was reported that on or around April 11, 2021, Resident 1 (R1) was observed sitting on their own feces, and feces were also observed in R1's bathroom and on the recliner. It was reported that on or around May 4, 2020, feces were observed smeared on R1's toilet seat.

During the investigation on 11/23/25, LPA interviewed the Business Manager (BM) and three (3) staff members (S1-S3), none of whom could confirm the allegation. LPA also interviewed ten (10) residents (R2-R11), none of whom could corroborate the allegation or report any complaints or concerns about their toileting needs not being met. In addition to these interviews, LPA conducted a physical plant inspection of randomly selected resident rooms and common areas. During this inspection, LPA did not detect any fecal or urine odor throughout the physical plant. Moreover, during resident interviews, LPA observed that these residents were appropriately cared for.

Based on the information obtained, there was insufficient evidence to prove that staff do not address a resident's toileting needs while in care or a resident being left soiled while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur, therefore the allegation is unsubstantiated.

Report Continued on LIC9099C

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20210623121750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLA VILLAGGIO
FACILITY NUMBER: 331880645
VISIT DATE: 05/04/2026
NARRATIVE
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Resident sustained an injury from a fall while in care:

Regarding the allegation, it was reported that on or around April 21, 2021, R1 fell at about 6:30 p.m. while attempting to go to the bathroom. R1 was transported to the hospital and placed in the ICU for four days due to a traumatic brain injury. It’s reported that the facility has no call buttons for elderly residents and those with limited mobility to get help.

During the investigation on 11/23/25, LPA interviewed the Business Manager (BM) and three (3) staff members (S1-S3), who could not confirm the allegation because they either did not know who R1 is or were not working at the facility at the time of the incident on or around April 21, 2021. On 11/23/25, LPA also interviewed ten (10) residents (R2-R11). The interviews revealed that not all ten residents knew who R1 is.

The LPA interviewed the Administrator and requested a copy of the Incident Report (IR) for R1’s fall on April 21, 2021. The administrator stated that, because the incident occurred almost 5 years earlier, the IR could not be located or obtained. The LPA toured the facility and visited rooms 111 and 201. The LPA pulled the call buttons in each resident room, and staff arrived within 1 to 2 minutes.

Based on the information obtained, the allegation of R1 sustaining an injury from a fall while in care cannot be confirmed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20210623121750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLA VILLAGGIO
FACILITY NUMBER: 331880645
VISIT DATE: 05/04/2026
NARRATIVE
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Resident was charged for services not received:

Regarding the allegation, it was reported that the additional pay charged for R1 for additional care and supervision, including physical assistance with toileting, was not met.

During the investigation on 11/23/25, LPA conducted interviews with the Business Manager (BM) and three (3) staff members (S1-S3), who could not confirm the allegation because staff either did not know who R1 was or were not working at the facility when the resident lived there.

In addition to interviewing staff, LPA interviewed ten (10) residents (R2-R1), all of whom did not report any complaints or concerns about their needs not being met.

The LPA review of R1’s medical assessment indicates that R1 requires assistance with bathing and toileting. However, the review of R1’s Admission Agreement does not confirm that R1 was paying additional charges for physical assistance with toileting, as this section of the Admission Agreement indicates no arrangements were made to pay for additional services. Only the agreed-upon basic services were included. Furthermore, R1’s Admission Agreement indicates a Level 1 level of care, and on page 32 of the Admission Agreement dated December 12, 2018, R1 declined the additional service.

Report Continued on LIC9099C

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20210623121750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLA VILLAGGIO
FACILITY NUMBER: 331880645
VISIT DATE: 05/04/2026
NARRATIVE
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Based on the information obtained, it could not be proven that a resident was charged for services not received. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted. A copy of this report was provided to the Administrator Eloiza Castellanos.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5